EP1659955B1 - Dispositif hydraulique de tension de ligaments - Google Patents

Dispositif hydraulique de tension de ligaments Download PDF

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Publication number
EP1659955B1
EP1659955B1 EP04764613A EP04764613A EP1659955B1 EP 1659955 B1 EP1659955 B1 EP 1659955B1 EP 04764613 A EP04764613 A EP 04764613A EP 04764613 A EP04764613 A EP 04764613A EP 1659955 B1 EP1659955 B1 EP 1659955B1
Authority
EP
European Patent Office
Prior art keywords
tensioning device
ligament tensioning
ligament
bearing plate
hydraulic
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Not-in-force
Application number
EP04764613A
Other languages
German (de)
English (en)
Other versions
EP1659955A1 (fr
Inventor
Christoph Fankhauser
Daniel Delfosse
Beat Salzgeber
Bernhard Clausen
Alain Moreillon
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synthes Bettlach GmbH
Original Assignee
Mathys AG Bettlach
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE10348585A external-priority patent/DE10348585A1/de
Application filed by Mathys AG Bettlach filed Critical Mathys AG Bettlach
Publication of EP1659955A1 publication Critical patent/EP1659955A1/fr
Application granted granted Critical
Publication of EP1659955B1 publication Critical patent/EP1659955B1/fr
Not-in-force legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0268—Joint distractors for the knee

Definitions

  • the invention relates to a ligament-tensioning device for skeletal parts, in particular joints of the human or animal body according to the preamble of claim 1.
  • the device described therein for tensioning ligaments on non-spherical joints on the human or animal body comprises a prismatic, cylindrical or plate-shaped base body with a right claw and a left claw whose bearing surfaces parallel to the joint-side surface of a first to a non-spherical joint adjacent bone can be brought to the plant.
  • the ligament-tensioning device has a right handle and a left handle, a right cocking lever and a left cocking lever with second bearing surfaces, which are arranged parallel to the first bearing surfaces, wherein between the respective bearing surfaces of the right clamping lever and the right claw a span Y and between the respective Pads of the left clamping lever and the left claw the same or another span X is adjustable.
  • the second bearing surfaces can be brought to bear on the joint-side surface of a second bone adjacent to the joint.
  • the apparatus comprises a right operating lever and a left operating lever, which are operable simultaneously with the holding of the device with one hand on the respective handle individually with the same hand and a right parallel displacement device and a left parallel displacement device, each driven by the corresponding operating lever are and are thus connected to a respective clamping lever, that during a movement of the operating lever, the spans X and Y are independently adjustable.
  • the Parallel displacement devices are designed as a four-joint lever mechanism.
  • a disadvantage of the WO 00/78225 A1 known ligament-tensioning device is in particular that the joint or the joint capsule must remain partially open during the tension of the ligaments (ligaments) for the purpose of insertion of the ligament-tensioning device. This results in some ligaments not being in their physiological (natural) position. As a result, measurements of the ligament tension, which are necessary for the correct setting, for example, in the introduction of prostheses in the joint, falsified what z. B. in too strong or too weak tension after the introduction of the prosthesis and postoperative complications can result.
  • the WO-A-03/003951 discloses a ligament-tensioning device having the features of the introductory part of claim 1.
  • the invention is therefore based on the object to provide a ligament-tensioning device, which makes it possible to clamp the capsular ligament structures of a prosthetic skeletal part to be treated, in particular joint, in the natural position of the ligaments and soft tissue structures.
  • the tension of the ligaments takes place via a ligament-tensioning device with a hydraulic adjusting device.
  • a force-displacement diagram can be measured during the operation, so that the knowledge gained thereby can be incorporated into the further course of the operation, in particular the selection of the prosthesis components.
  • the pressure of the hydraulic medium is a measure of the force.
  • the supplied volume of the hydraulic medium is a measure of the way.
  • the ligament-tensioning device has in this case a first and a second abutment plate, which are brought into abutment against the respective skeletal parts and are displaceable relative to each other by the hydraulic adjusting device in the proximal-distal direction.
  • bearing plates are interconnected by a base body in which the hydraulic actuator is arranged.
  • the smooth surface of the second bearing plate advantageously allows a free movement of the femur depending on the position of the joint and thus an unstrained position of the ligaments.
  • FIGS. 1A to 1C show, in various schematic, perspective overall views, an exemplary embodiment of a ligament-tensioning device 1 designed according to the invention for a knee joint, which is hydraulically adjustable.
  • the ligament-tensioning device 1 comprises a first, distal abutment plate 2 and a second, proximal abutment plate 3.
  • the abutment plates 2, 3 are symmetrically formed in two parts and formed so that they can be brought into abutment on skeleton parts not shown. In the described embodiment, these are the skeletal parts of a knee joint.
  • the first, distal abutment plate 2 has a distal tibial bearing surface 4, which abuts against the bone section of the tibia (Tibia). It has a planar design and has an outer contour adapted to the shape of the tibial bone, which preferably terminates flush with the tibial bone at the edge.
  • the second, proximal abutment plate 3 has a proximal femoral abutment surface 5, which abuts against the condyles of the femur (femur).
  • This one can according to the roundish shape of the condyles have adapted, also rounded contour.
  • the contact surface 5 is smooth or even polished to allow an approximately frictionless movement of the femur on the contact surface.
  • the second, proximal contact plate 3 is smaller than the first, distal contact plate 2, since the contact surface of the femoral condyles is smaller than the contact surface of the tibial bone.
  • the bearing plates 2, 3 are interconnected by a base body 6, which has an anchoring pin 7.
  • the ligament-tensioning device 1 is anchored in the tibia.
  • a bone cavity is introduced into the tibial bone, which receives the tibial part of a knee joint prosthesis during the further course of the operation in the case of the prosthetic restoration of a knee joint.
  • the first, distal abutment plate 2 is fixed to the base body 6, while the second, proximal abutment plate 3 is connected to the base body 6 via an axis 8, which allows tilting of the second, proximal abutment plate 3 relative to the first, distal abutment plate 2.
  • the tilting movement takes place in the frontal plane in varus-valgus direction.
  • the joint can move freely and unstrained despite strained ligament-tensioning device 1, when the bones are bent relative to each other. This is particularly important with regard to the preparation of the prosthetic restoration of a joint, since the overall situation of the ligamentous structures in the region of the joint, their number and tension must be examined before the implantation of a prosthesis.
  • the base body 6 comprises a hydraulic adjusting device 9, which allows a change in the position of the bearing plates 2, 3 to each other in the proximal-distal direction.
  • the hydraulic actuator 9 comprises, as shown in Fig. 1D, a supply line 10 through which the hydraulic medium is supplied.
  • Hydraulic medium is preferably a biocompatible fluid such as isotonic saline solution provided, since this causes no problems in the surgical field in case of leakage or breakage of the supply line 10.
  • the hydraulic medium is pressed under high pressure into the supply line 10 and actuates a arranged in the hydraulic actuator 9 in the anchoring pin 7 piston 11, which is in operative connection with the second, proximal contact plate 3.
  • a guide pin 12 is provided, which extends parallel to the piston 11 and is guided in a recess 13 of the base body 6.
  • the piston 11 acts upon application of pressure to the axis 8 and thereby displaces the second, proximal contact plate 3 in the proximal direction.
  • the second, proximal contact plate 3 moves back distally due to the tension of the ligaments.
  • the pressure required to act on the hydraulic ligament tensioning device 1 is provided by a hydraulic unit (not shown) via a drive unit 14.
  • the drive unit 14 is shown in FIGS. 2A to 2C in different views. Only the components essential to the invention are explained.
  • the drive unit 14 may otherwise be constructed in a known manner.
  • a stepper motor 15 is arranged parallel to a shaft 16 of the hydraulic unit.
  • a gear 17 of the stepping motor 15 engages in a toothing 18 of the shaft 16 a. By the rotation of the gear 17 of the stepping motor 15, the shaft 16 of the hydraulic unit is driven.
  • a pressure sensor 19 for the prevailing pressure in the hydraulic line 10 and a vent valve 20 are provided.
  • the hydraulic line 10 is connected by means of a suitable connection 21 to the drive unit 14 and leads to the ligament-tensioning device 1.
  • FIG. 2C which is a section through the drive unit 14 shown in FIG. 2B along the line labeled II-II
  • rotation of the shaft 16 of the hydraulic power unit will cause a pin 22 disposed in the shaft 16 moved in an axial direction of the shaft 16.
  • the pressure in a volume 23 filled with hydraulic medium is increased or decreased depending on the direction of rotation.
  • One or more sealing rings 24 prevent the escape of the hydraulic medium.
  • a biocompatible fluid such as isotonic saline or any other antiseptic rinse solution is suitable as the hydraulic medium.
  • the pressure in the volume 23 filled with hydraulic medium can be arbitrarily and continuously increased or reduced, and the ligament-tensioning device 1 can thereby be clamped or relieved as desired.
  • the pressure sensor 19 and / or by the integration of the inventively designed ligament-tensioning device 1 the pressure values can be documented in a suitable manner.
  • the documentation of the force associated with a specific pressure value and thus with a defined path of the piston 11 of the ligament-tensioning device 1 and a defined extension of the ligaments makes it possible to record a force-displacement diagram z. B. for the prosthetic to be treated joint in a flexion range between 0 ° and about 120 °.
  • the tensile force exerted by the ligaments must behave constantly over the flexion area.
  • conventional ligament-tensioning devices 1 allow only the static spreading of the joint under a defined flexion angle, on the other hand the ligaments are displaced from their natural position by the attachment of the ligament-tensioning device 1, so that it is impossible to adjust the ligament tension when the ligament-tensioning device 1 is applied.
  • both a flexion of the joint with applied ligament tensioning device 1 is possible because the smooth or polished contact surface 5 of the second contact plate 3 allows a free adjustment of the bone position according to the respective Felxionslage, on the other hand, the ligaments are due the compact shape and the hydraulic actuation of the ligament tensioning device 1 in its natural position, since the hinge or the capsule capsule apparatus can be completely closed after inserting the ligament-tensioning device 1 down to a small opening through which the supply line 10 is guided , so that the preoperative situation can be restored except for small deviations. After the prosthetic restoration of the joint, individual ligaments can then be loosened directly to the extent necessary to achieve optimal mobility of the joint over the entire flexion area.
  • the inventively designed ligament-tensioning device 1 can by their special shape and operation to a detailed preparation for the prosthetic restoration with optimal approximation to the situation of an intact joint.
  • the ligament-tensioning device according to the invention can be used not only on joints, but also on other skeletal parts, For example, also be used for spreading of vertebral bodies in disc surgery.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Claims (19)

  1. Dispositif de tension de ligaments (1) pour l'activation de l'appareil ligamentaire et/ou capsulaire pendant l'implantation d'un implant du squelette avec une première plaque d'appui distale (2) pour l'application sur une première partie de squelette et une deuxième plaque d'appui proximale (3) pour l'application sur une seconde partie de squelette, dans lequel la première plaque d'appui distale (2), en opposition à la seconde plaque d'appui proximale (3), peut être déplacée par un dispositif d'ajustement hydraulique (9),
    caractérisé en ce que
    la première plaque d'appui (2) et la seconde plaque d'appui (3) sont reliées entre elles par un corps de base (6), dans lequel est agencé le dispositif d'ajustement hydraulique (9) du dispositif de tension de ligaments (1).
  2. Dispositif de tension de ligaments selon la revendication 1,
    caractérisé en ce que
    la première plaque d'appui (2) est raccordée solidement au corps de base (6).
  3. Dispositif de tension de ligaments selon la revendication 2,
    caractérisé en ce que
    la seconde plaque d'appui (3) est raccordée par un axe (8) mobile au corps de base (6).
  4. Dispositif de tension de ligaments selon la revendication 3,
    caractérisé en ce que
    la seconde plaque d'appui (3) est agencée en opposition à la première plaque d'appui (2), de façon à pouvoir basculer dans le plan médian latéral.
  5. Dispositif de tension de ligaments selon l'une des revendications 1 à 4,
    caractérisé en ce que
    sur le corps de base (6), est configuré un tenon d'ancrage de tibia (7).
  6. Dispositif de tension de ligaments selon l'une des revendications 1 à 5,
    caractérisé en ce que
    le dispositif d'ajustement hydraulique (9) présente un piston (11) disposé dans le corps de base (6) et le tenon d'ancrage (7).
  7. Dispositif de tension de ligaments selon la revendication 6,
    caractérisé en ce que
    le piston (11) se trouve en liaison efficace avec la seconde plaque d'appui proximale (3).
  8. Dispositif de tension de ligaments selon la revendication 6 ou 7,
    caractérisé en ce que
    un pivot de guidage (12) parallèle au piston (11) est guidé dans un évidement (13) du corps de base (6).
  9. Dispositif de tension de ligaments selon l'une des revendications 1 à 8,
    caractérisé en ce que
    le dispositif d'ajustement hydraulique (9) présente une conduite d'amenée (10).
  10. Dispositif de tension de ligaments selon l'une des revendications 1 à 9,
    caractérisé en ce que
    le dispositif d'ajustement hydraulique (9) est rempli d'un agent hydraulique.
  11. Dispositif de tension de ligaments selon la revendication 10,
    caractérisé en ce que
    en tant qu'agent hydraulique, on utilise une solution biocompatible.
  12. Dispositif de tension de ligaments selon la revendication 10 ou 11,
    caractérisé en ce que
    en tant qu'agent hydraulique, on utilise une solution d'eau salée isotone.
  13. Dispositif de tension de ligaments selon l'une des revendications 10 à 12,
    caractérisé en ce que
    la pression de l'agent hydraulique sur le piston (11) peut être régulée en continu au moyen d'une unité d'entraînement (14).
  14. Dispositif de tension de ligaments selon la revendication 13,
    caractérisé en ce que
    l'unité d'entraînement (14) comporte un moteur pas à pas (15).
  15. Dispositif de tension de ligaments selon la revendication 14,
    caractérisé en ce que
    le moteur pas à pas (15) entraîne, par l'intermédiaire d'une roue dentée (17) et d'une denture (18), un arbre (16) d'un ensemble hydraulique.
  16. Dispositif de tension de ligaments selon la revendication 15,
    caractérisé en ce que
    un pivot (22) est agencé dans l'arbre (16) par le déplacement axial duquel on obtient une augmentation progressive ou une diminution d'un volume (23) contenant l'agent hydraulique.
  17. Dispositif de tension de ligaments selon l'une des revendications 13 à 16,
    caractérisé en ce que
    l'unité d'entraînement (14) présente un capteur de pression (19).
  18. Dispositif de tension de ligaments selon l'une des revendications 13 à 17,
    caractérisé en ce que
    l'unité d'entraînement (14) présente un raccordement (21) pour une conduite hydraulique (10).
  19. Dispositif de tension de ligaments selon l'une des revendications 1 à 18,
    caractérisé en ce que
    la surface d'appui proximale (5) de la seconde plaque d'appui proximale (3) présente une surface lisse et/ou polie.
EP04764613A 2003-09-04 2004-08-30 Dispositif hydraulique de tension de ligaments Not-in-force EP1659955B1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE10340885 2003-09-04
DE10348585A DE10348585A1 (de) 2003-09-04 2003-10-20 Hydraulische Bänderspannvorrichtung
PCT/EP2004/009645 WO2005023120A1 (fr) 2003-09-04 2004-08-30 Dispositif hydraulique de tension de ligaments

Publications (2)

Publication Number Publication Date
EP1659955A1 EP1659955A1 (fr) 2006-05-31
EP1659955B1 true EP1659955B1 (fr) 2007-10-17

Family

ID=34276537

Family Applications (1)

Application Number Title Priority Date Filing Date
EP04764613A Not-in-force EP1659955B1 (fr) 2003-09-04 2004-08-30 Dispositif hydraulique de tension de ligaments

Country Status (3)

Country Link
EP (1) EP1659955B1 (fr)
DE (1) DE502004005284D1 (fr)
WO (1) WO2005023120A1 (fr)

Families Citing this family (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7615055B2 (en) * 2005-03-31 2009-11-10 Depuy Products, Inc. Method and apparatus for use in balancing ligaments of a knee
US8635082B2 (en) 2006-05-25 2014-01-21 DePuy Synthes Products, LLC Method and system for managing inventories of orthopaedic implants
US8197489B2 (en) 2008-06-27 2012-06-12 Depuy Products, Inc. Knee ligament balancer
US8551023B2 (en) 2009-03-31 2013-10-08 Depuy (Ireland) Device and method for determining force of a knee joint
US8721568B2 (en) 2009-03-31 2014-05-13 Depuy (Ireland) Method for performing an orthopaedic surgical procedure
US8556830B2 (en) 2009-03-31 2013-10-15 Depuy Device and method for displaying joint force data
US8740817B2 (en) 2009-03-31 2014-06-03 Depuy (Ireland) Device and method for determining forces of a patient's joint
US8597210B2 (en) 2009-03-31 2013-12-03 Depuy (Ireland) System and method for displaying joint force data
GB201115411D0 (en) 2011-09-07 2011-10-19 Depuy Ireland Surgical instrument
US9381011B2 (en) 2012-03-29 2016-07-05 Depuy (Ireland) Orthopedic surgical instrument for knee surgery
US10098761B2 (en) 2012-03-31 2018-10-16 DePuy Synthes Products, Inc. System and method for validating an orthopaedic surgical plan
US10070973B2 (en) 2012-03-31 2018-09-11 Depuy Ireland Unlimited Company Orthopaedic sensor module and system for determining joint forces of a patient's knee joint
US10206792B2 (en) 2012-03-31 2019-02-19 Depuy Ireland Unlimited Company Orthopaedic surgical system for determining joint forces of a patients knee joint
US9545459B2 (en) 2012-03-31 2017-01-17 Depuy Ireland Unlimited Company Container for surgical instruments and system including same
US11344352B2 (en) * 2019-03-29 2022-05-31 Depuy Ireland Unlimited Company Methods of operating a surgical instrument and performing a surgical procedure to balance a patient's knee

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6022377A (en) * 1998-01-20 2000-02-08 Sulzer Orthopedics Inc. Instrument for evaluating balance of knee joint
DE29910761U1 (de) * 1999-06-19 2000-11-23 Mathys Medizinaltechnik Ag Bet Bänderspannvorrichtung für nicht-kugelige Gelenke
NL1018438C1 (nl) * 2001-07-02 2003-01-08 Baat Medical Engineering B V In- en uitklapbaar gereedschap voor plaatsing in een ruggenwervel.
FR2840189B1 (fr) * 2002-05-30 2005-03-11 Jean Pierre Gemon Ecarteur hydraulique
DE20310289U1 (de) * 2003-07-04 2003-09-04 Aesculap Ag & Co Kg Vorrichtung zur Befüllung eines hydraulisch distrahierbaren Wirbelkörperdistraktors

Also Published As

Publication number Publication date
DE502004005284D1 (de) 2007-11-29
EP1659955A1 (fr) 2006-05-31
WO2005023120A1 (fr) 2005-03-17

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